Clarification Of Comments On Medical Battery

July 25, 2008

My blog post the other day about the surgeon who committed battery by placing a temporary tattoo on an unconscious patient has generated quite a bit of, shall we say, consternation among some physicians and surgeons. In re-reading the post, I see that it was written in a way that was overly hyperbolic and generalized even for PhysioProf.
And for that, I am genuinely sorry. As bloggers, we always try to create controversy and argument, but I see that in this case I went too far.
Although I am not an MD, I love being a peripheral part of the medical profession, love being a basic science faculty member at a medical school, and love teaching medical students. I care very deeply for my medical students, and spend a lot of time and effort on effective teaching. I also have great affection for them, and wish them only the best in their future medical careers.
And that is why I am so concerned about the behavior of the “tattoo surgeon”. I do see an issue with paternalism, arrogance, and omnipotence in the profession, and I do not see the behavior of this surgeon as being solely attributable to a “lone bad actor”. Bad acts occur in a context, and I believe that to at least some extent, the medical profession includes a context that makes bad acts like this one more likely.
Accordingly, I disagree strenuously with something PalMD posted today about this issue:

The days of systematic pathologic paternalism on the part of doctors is long gone. It may linger in places, but it’s just not part of the culture anymore.

I believe this is not true, and it harms the medical profession to pretend that there is no longer an issue to be addressed.

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In re-reading the post, I see that it was written in a way that was overly hyperbolic and generalized even for PhysioProf.
Dude, now you’re being a wuss. Whatever the merits of your original comment, it was worth it if only for the hysterical reactions (“I can not believe that anyone on ScienceBlogs would ever engage in mean-spirited, bigoted generalizations!”) from the MDs. And now you’re backing down because a bunch of throat-swabbers are upset at you?
Everyone here dishes it out a lot more enthusiastically than they take it, but even so…

What? An actual apology? Taking responsibility that you went too far on this one? ..but..but, isn’t it somehow Orac and MarkH’s problem that they took offense? Isn’t that the way this is supposed to go?

Here’s the thing. It’s a blog; they’re hyperbolic a lot of the time and it wasn’t that hyperbolic. Here’s the other thing. PhysioProf is right and PalMD is dead wrong. Here’s the last thing: Orac getting inflamed about a hyperbolic post? Paging Dr Black Kettle, Dr Black Kettle.

“I believe this is not true, and it harms the medical profession to pretend that there is no longer an issue to be addressed.”
Fine.. then you’ll have no problem backing up your belief with statistics. *Waits*

Fine.. then you’ll have no problem backing up your belief with statistics. *Waits*
Do you need help with reading comprehension Martin? When someone reports their personal experiences as such, where is the problem? We accept those for what they are and move on. Got another perspective, fine, let’s have it. I’ll respect your experiences as such, PPs as what they are and integrate with my own. Where’s the problem here?
Even the MDs are admitting that some fraction of their peers are dickweeds so all this whinging is just over whether any credible listener hears “there are some systematic problems in a given profession” as “each and every member of that profession expresses the worst possible traits to ELEVENTY!!!!!!” That’s what the MDs are hearing but it sure as shit isn’t what I’m hearing in this!

I’ve witnessed all manner of flame wars across ScienceBlogs writers within and outside the collective. Virtually without exception, these disagreements have escalated to the point that each side becomes so entrenched in their position that they become recalcitrant to reason.
Your critics might have expected you to be among the last writers to ever issue a mea culpa. In fact, in my 26 months as part of this network I have yet to find any blogger admit they were wrong, offer an olive branch, and acknowledge that their post took a specific situation and overgeneralized about a profession (but still distill out a reasonable argument that challenges the status quo).
I may not always agree with you but I respect you for posting this follow-up. I challenge your critics to do the same on any other issue.

I call bullshit. You’re not sorry, you’re just scared. Scared because you know you’re entire gimmick is being a loudmouth prick online and you felt it was catching up with you professionally. I recall another time a similar mushy appeal to loving medical students was issued when the chickens threatened to come home to roost.
The post was beyond the pale. Take it down and replace it with an apology for being totally incorrect. This post is a non-apology. All you have done is start with an apology, say you love medical students, and then just repeat the same slander, evidence-free. Even then you probably aren’t totally safe.
And angrytox, when is Orac hyperbolic? When is he anything but measured, and if anything, excessively patient and thorough when dealing with BS. I keep seeing these counter-accusations, but not a lot of good examples. Where do we castigate an entire wing of scientists or professionals? When do we spit out a string of fucks directed at our colleagues and students? And what is the proof that medicine has not done an excellent job in weeding out paternalism (short of firing all doctors over 60)? Some attitudes take time to fully disappear, but trust me, the culture is dramatically changed. And why are all sbers now being painted with the PZ brush? I don’t recall db defending PZ, in fact I remember Pal taking a very moderate take on that fiasco.

Disagree with MarkH. I’m for leaving the post as is. People are entitled to his/her opinion. People are also allowed to clarify and/or change his/her opinion, because that is what mature, thinking people do.

MarkH, PP wrote a post citing a particularly egregious example of sexist and paternalistic behavior. He went too far in generalizing about an entire profession. He realized that he had done so and he apologized and clarified. You ask him to cite evidence of his claim. I call bullshit on you. We are far beyond the point of having to cite evidence of sexism and paternalism in this society. It is pervasive. Must we cite Hodgkin and Huxley when we mention an action potential? PP is calling out the medical profession in exactly the same way that he has repeatedly called out the basic science profession.
I am not an MD, I am a basic scientist. I have no problem understanding that my profession has a major problem on its hands in the way it has historically and currently undervalues and mistreats women. Sure, things have improved in recent years but we have a long, long way to go. Your profession has the same problem and likely has a longer way to go. The sooner you recognize this and motivate yourself to do your part in changing the culture the better off your profession will be. PP has already done this for his own field and I can only imagine that his actions at his place of work speak far louder than his blog posts.

All professions tend to have a glass ceiling for women, the women’s revolution is still incomplete, I agree. I’ve seen this in basic science as well. It’s getting better, but much of the problem is waiting for the old guard to die.
Medicine, by the way, is constantly trying to address these things. Last week the AMA apologized for it’s history of racism towards black doctors and is starting a nation-wide initiative to eliminate racial disparities in medical care. Women are doing much better in medicine but there are still deficiencies – like we write about at denialism blog. We do have a long way to go. However what PP says is false. It is little more than a bigoted lie. These attitudes are not inculcated in our training. If anything, medical training is very humbling, and medical schools nationwide strive to make things better for women, minorities, and remind us never to act in the way PP describes.
His post stands at Feministe with no apology attached. He has commented here on his blog but has done nothing to change the message there. The message is little more than a slander, that doesn’t describe either the medical profession or medical training accurately. I would expect such a hateful and false post from an anti-medicine crank – not from a PhD, not a scientist, not someone teaching medical students, and not from someone sharing my network. (insert but, but, but PZ coment here).
I reiterate that it is also potentially career-ending error. When one’s peers hear one of their own slandering them, they get mad. When this happens at medical schools, people get fired. I almost got canned when someone misquoted me to make it sound like I was insulting surgeons. PP openly slandered his colleagues. What an idiot. He is not safe while that post is up, because eventually he’ll get exposed, or one of the many people who already know who he is will forward such an article to his surgical professor peers. It will not be me, don’t worry. But he’s playing with fire.

PhysioProf posted his apology at Feministe. And whether you mean it to or not, your “reiteration” comes across as one more veiled threat to out PP or an encouragement to others to do so for you. I would have thought that was beneath you, Mark, but you keep doing it.

Really, Janet? I read Mark’s comments as an extension of PalMD’s thoughts during the Great Pseudonymity Debate; i.e., none of us who blog(ged) that way are as well-hidden as we think and we might want to watch that it doesn’t come back to bite us if we’re outed. I didn’t read it as a threat then. I don’t now.

And why are all sbers now being painted with the PZ brush?
What I found amusing (besides the guy waxing indignant about the commitment of MDs to large sample sizes in their research) wasn’t “painting with the PZ brush”. It was how you were shocked, shocked to find:As a member of the scienceblogs community, it is understandably upsetting to see a evidence-free rant, based on bigotry, from a scibling…

Jesus Janet, how many ways do I have to say it? I’m not going to out him. For some reason I feel compelled to give the very good advice that one shouldn’t rely on the fleeting anonymity of the internet, especially when committing error #1 of blogging – insulting colleagues.
From personal experience I know how dangerous this can be, and that even complementary commentary about colleagues may be misconstrued with unfortunate consequences. Am I trying to scare him? Yes, absolutely. He should be scared. He’s made a terrible error. Am I threatening him? No. I have promised in multiple venues, public and private, not to expose them. I am trying to point out that they should be more careful, that they should be scared, but not threatened by the fact that they have behaved carelessly, and dangerously. Considering how little I like these two bloggers I think this is, if anything, a kindness. Keep interpreting it negatively as much as you like, but I would never be so stupid as to threaten someone. Knowing my personality you should realize I would have just acted.

I made an error, I did not see an apology at the feministe main page. However, I still assert it is an error to leave that post up – and that the apology should be attached to the original slanderous piece of garbage he wrote.
Again, not being threatening, that post is a liability. It could ruin a fledgling professor who is untenured. Stop hearing threats and start hearing advice, this post is a disaster waiting to happen.

Accordingly, I disagree strenuously with something PalMD posted today about this issue:

The days of systematic pathologic paternalism on the part of doctors is long gone. It may linger in places, but it’s just not part of the culture anymore.

I believe this is not true, and it harms the medical profession to pretend that there is no longer an issue to be addressed.

So you still believe there is systematic pathologic paternalism? Nonsense. We have whole classes at my university devoted to relieving us of paternalistic impulses. There may be paternalism, which Pal admits to in this quote as something that still happens, but systematic? Really? From where? Another BS slander. Quit trying to act like you had a valid point. There is no systematic attempt to breed godlike monsters. Our profession is not perfect, but the error is not systematic. It is random. You’re a PhD, you should know the difference by now.
This is why your apology is not an apology. You say your initial criticism was overblown – you asserted a systematic error exemplified by a single monster’s misbehavior. However, this was a random error. Not evidence of a systematic problem. You still just don’t get it. You keep repeating the same slander.

Bloody hell, veiled threats to expose an anonymous blogger to try to ruin his or her career. This must be a new low for scienceblogs. This sort of behaviour would be considered unethical on a football hooligan site and yet its fine on scienceblogs? Shame on you.

Janet, Sigmund, Mark has already said he’s not making threats. If you want to keep accusing him, own up and say, “I don’t believe you,” or, “I read this as a threat no matter what you say.” Unless Mark says, “I will tattle on PP,” the threat is interpreted behavior. Take responsibility for your interpretation.
I never thought I’d say this, but read PP’s post here to see how it’s done.

And whether you mean it to or not, your “reiteration” comes across as one more veiled threat to out PP or an encouragement to others to do so for you

makes it clear what my interpretation of Mark’s comments is. He (and you) can jump up and down and say “That’s not what I meant (but you should be scared)” as many times as you like, but that does not mean that a reasonable reader cannot read menace in the comments.
If you’re telling me that my “responsibility” here is to believe that the only reasonable interpretation of Mark’s comments is the harmless one he offers, I respectfully disagree.

MarkH, keep digging. With each additional crazed hypocritical tirade, you further reinforce your emotional and intellectual kinship with the “cranks” you rail against.
You keep throwing around the legal term “slander”. Ask your brother to explain to you what it means, and why it (and libel) are utterly inapplicable to PP’s completely non-individualized general observations of the medical profession. While your own emotional weaknesses apparently lead you to personalize even the most general statements–perceiving them as direct individualized attacks on you and your family–your brother can explain to you the legal realities.
Do you think your obsessive over-the-top crusade is going to look good to your medical school, as a sign of your calm, rational approach to potentially stressful situations?

Geez Physio Prof, Never Complain, Never Explain. You just lost some Bigtime Tenurepoints on your Man Card. You can make it up by answering one question. “Have you ever picked up a Chick by telling her you were a “Doctor”?”

Dr. Free Ride,
I don’t understand the point you are making here. When you bold the words “come across” are saying that you are (as Stephanie is suggesting) asserting that MarkH is threatening PP with outage, or are you saying that your prior statement did NOT say that.
You need to make yourself more clear and not write in such a way that your meaning is always up for grabs.

Actually, Janet, I’m telling you that putting your own opinion in the mouths of “reasonable readers” is a rhetorical strategy that you shouldn’t have to use if your point is valid. I’m also saying that not acknowledging the known difference of opinion on what Mark is doing–a difference that you and Mark have already apparently addressed elsewhere–is weaselly behavior. I’m suggesting you stand up and claim your own opinion without relying on some hypothetical masses to back you up. Put it out there as yours and see whether it flies without exerting social pressure for people to agree with you.

Stephanie, in small words and direct sentences:
1. I think Mark is being threatening.
2. Even if Mark says he does not mean to be threatening, I still think there’s a threat.
3. I don’t think, from his words or tone, it is wrong for me to come to this conclusion.

MarkH is a hypocritical threatening nut, and with each further obsessive comment, he reinforces the perception of his hypocritical threatening nuttiness. It is frightening that he is going to be allowed to treat patients.

@Dr. Free-ride/Janet.
Am I trying to scare? Yes. Am I threatening? No.
I am pointing out the potential consequences of his actions. I have said I will not be the one to make those consequences happen, but they are there, and a very real risk. This is the truth. I’m showing him “Blood on the Highway” so he’ll drive slower. I’m showing the pictures of STDs to he’ll use a rubber.
This is error #1 of blogging people. Don’t make the same mistake at your blogs.

Thank you, Janet, although the “small words” crack was really quite gratuitous.
I think you and I both identify a threat, as does Mark. I think we disagree on where that threat comes from. Mark did not say that he doesn’t mean to be threatening, but that he was not making any threat–identity versus behavior. And I think you’re wrong to attribute a threat to Mark that Mark is attributing to the situation.
It’s quite clear that Mark is angry with PP, which explains the tone. The words are a direct paraphrase of an earlier argument about just this kind of threat. The only thing that has changed between that argument and this is perhaps that the stakes of PP being wrong have gone up.
Now, if you want to ask Mark to make a statement that he doesn’t want anyone to out PP over this, ask him. As he said above, if he wanted it done, he’d have done it.

MarkH: There are more possibilities for characterizing these behaviors and attitudes in the medical profession besides systemic and random. It could be endemic, a non-random presence due to vestigial attitudes and/or external structural forces that help replicate these behaviors. I’m not saying that’s necessarily the case; my point is that we need not choose between PP’s “systemic” and your “random.”
PhysioProf: Some unsolicited advice: Stop using the word “fuck” so much in your posts. It makes you look infantile and unprofessional.
All of us could use a little less yellow bile and a little more phlegm. (I jest. But seriously, let’s all try to be a little more even keel and restrain ourselves from making overly sweeping and passionate characterizations.)

MarkH nearly got his ass thrown out of medical school for stupidly blogging about the actions of particular individually identifiable surgeons involved in his training program. PP made a non-individualized general observation about the medical profession. It doesn’t say much for MarkH’s prospects of future exercise of good ethical and practical judgment that his emotional weaknesses preclude him from comprehending the big difference.

I just want to add my voice to this. The on line personae and behavioral proclivities of the Drugmonkey and PhysipProf acts are very different from each other (last time I put them in the same boat one of them got really mad and told me so) yet similar to each other in that they the shock-jock analog for the blososphere. If you are going to act that way, then you have to understand the following things:
1) When you go after someone, they are not going to like it or respond nicely or as a pushover, whether you are right or wrong. If you want to engage in actual conversations you should rethink this approach.
2) Many, many people are not. going. to. like. you. That may not seem to matter but at some point it might. I see a reaction to this in your words, so I think it matters now.
3) legalistic arguing such as we see from PP, DM, and to some extent (only in a more passive aggressive way) from Dr. Freeride is not a way to win arguments. And, you seem to think that winning the argument is always the main objective. You really do have to rethink this strategy if you are here (on the internet) to actually engage in discussions about things, to make some kind of difference. If you are, rather, here in the blosophere so you can hear your own misanthropic voices then you’re doing great.
4) Something you need to know: (everybody is talking about his behind your backs). Nobody believes that most (any?) of the equally abrasive commenters that seem to be stroking you on this site (or elsewhere) are real. Everybody thinks they are sock puppets. Personally, I’m not saying that…. I’m giving you the benefit of the doubt and I personally know that at least some of them are not. But that is what everybody thinks. I’m just sayin’
5) You (the general ‘you’ … all people reading this) have to be pretty stupid or thick-skulled to not recognized MarkH’s reaction as one of utter frustration steeped in justified anger. This soup is made out of your ingredients, DM. Eat it.
6) My recommendation to Mark and others: Don’t link to these conversations. I stopped linking to Physiprof and Drugmonkey and I took them off my blog roll. I allow them to comment on my site but I change their link-back to a joke of some sort. They no longer bother me. They are link whores (like the rest of us … they are just very very bad at it)
7) All those of you who like anonymity or who think the practice of pseudonymous blogging is important and worthy for various reasons should fall upon these two bloggers, bloody them up, and throw them off the island from the highest cliff. Metaphorically, of course. They are ruining it for you!

Re: threat or no threat,
I certainly don’t think that MarkH is planning on ‘outing’ anybody, but I can see how his comments can be read that way. The appeals from Mark that it’s not a threat may be easier to accept if they weren’t prefaced with ‘because I’m such a nice guy’ or comments about doing PP a favor by not outing him.
If someone says to me, “I don’t like you and I don’t know why I’m doing this for you, but I won’t reveal your identity since I’m such a nice guy” (a paraphrase of a MarkH comment on his blog) I don’t think I would be that far out of line to read that as “I don’t like you and I don’t know why I’m doing this for you, but I won’t reveal your identity since I’m such a nice guy but that might change” (or at the very least a warning for next time I step out of line)

Comments about outing somebody, even if one says he will not do it, are totally irrelevant to the main topic. Let’s stay on topic. Perhaps the main topic is dead now.
Trying to win arguments online is kind of an endless endeavor. The main thing should be a discourse of ideas. And occassionally, agree to disagree.

Actually bmoc I was misquoted by another author to give the appearance I was insulting surgeons in general, not specific individuals. You simply don’t know what you’re talking about. When people read the misquote (on a much more prominent site) they got angry at me. The post itself was actually highly complementary of surgery (which I plan on pursuing as a career) and of the surgeons I had worked with. It was about how my expectations based on the prejudices of others about surgeons and their popular representations on television had been challenged and falsified by my personal experience.
I was largely saved by the actions of several surgeons I worked with who defended me by pointing out that I hadn’t said anything wrong, were not bothered by what I had actually written (most people enjoy compliments), and had merely been misquoted. The people angry with me hadn’t even read what I actually wrote.
What I learned was that even the perception of an internal critique of one’s colleagues may result in meetings with the dean and a need to clarify. Criticizing colleagues, even generally, is a bad idea online. It’s just a simple fact. I still write generally about what medschool is like, writing a post usually after each rotation about my impressions, but I’m even more careful than ever to avoid slights against the people I work with and think about every sentence from the point of view of it being misread, misquoted or used out of context. It’s very tedious.

Man, I am so staying out of this dumb argument (too many times have I watched this kind of INTERNEHT FITE spiral into the same dysfunctional, pointless fractals), but this made me laugh:
“Something you need to know: (everybody is talking about his behind your backs). Nobody believes that most (any?) of the equally abrasive commenters that seem to be stroking you on this site (or elsewhere) are real. Everybody thinks they are sock puppets. Personally, I’m not saying that…. I’m giving you the benefit of the doubt and I personally know that at least some of them are not. But that is what everybody thinks. I’m just sayin'”
LOL!!! Are we in middle school? “I just thought you should know that EVERYBODY is saying how, like, you know, you’re kind of like FAKE? Oh and by the way, your boyfriend is telling everybody that he actually thinks you’re UGLY.”

Eww what a disgusting thread.
First, of all the things PP has done, his suggestions that medical training might be a good environment for breeding arrogance somehow renders him a slanderous evil blogger will should be fired?
WTF?!
MarkH, I’m happy to take you at your word that you aren’t threatening PP. It’s not me who’s at risk after all! (and as far as I can tell, you do seem like a perfectly nice fellow in general). But your scare-mongering “let me show you this evil STD so you’ll wear a rubber” approach is rather repulsive (I don’t like it when people do it about STDs either).
Moreover, I can understand why Dr. Freeride read it as a threat- it did seem that way to me at first. Of course, I’m probably not what Stephanie Z had in mind as a “reasonable reader” (though I’m never quite sure with her…)
If there’s a detailed description of the professional difficulties you dealt with because of misconstured blogging, could you link to it? That would seem to me more on target than general insinuations that one can loose one’s job because one dares to say something uncomplimentary about a profession. You are probably right that one could loose one’s job over that- but I’d like to point out that that is some MESSED UP S***.
And Greggie? If you’re so high and mighty you won’t link to PP/DM, don’t come over here and play with our ball.
Also, YOU BROKE TEH INTERNETZ!11!!!eleventy!! Now go home.

Becca, my point was just that there isn’t a single type of reasonable reader, so the invocation of what the reasonable reader sees is useless at best. For the record, I think you’re pretty reasonable…you know, most of the time. 😉